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This is true. 2017 called they’d like their salaries back.
How Long?
- Thread starter Anesthesia_Guy
- Start date
This is true. 2017 called they’d like their salaries back.
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why do we use the public forum for stuff like this. I don’t get it.
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2023 is a year to make hay while the sun shines. If you need or want money then there is no excuse why in 2023 you can’t be earning a very high salary. As for me, I make a very good salary working 36-40 hours per week with 9 weeks vacation. I’m quite content with my pay for the work i do. Can you say the same?
I agree that one should be using the market incentives to either get a great job at average pay or a mediocre job at very high pay. Anyone covering 4 midlevels and working 55 hours or more per week should be killing it financially. I won’t even quote the salary I would demand in 2023 for such a position on the public forum. My advice is wake up and smell the roses 🌹 while they are still fresh.
I agree that one should be using the market incentives to either get a great job at average pay or a mediocre job at very high pay. Anyone covering 4 midlevels and working 55 hours or more per week should be killing it financially. I won’t even quote the salary I would demand in 2023 for such a position on the public forum. My advice is wake up and smell the roses 🌹 while they are still fresh.
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This is me. I have a job with good working conditions at average pay. I decided to go locums and staff a mediocre job at very high pay. I have already spoken to other recruiters who are offering the same rate or higher in my local area at other sites.
I have a surprisingly in demand sub specialty skill set, so I’m just going to go for it. My kids are young but it’ll hopefully get us better positioned for the future…. A future which I have absolutely no clue if it’ll be better or worse for anesthesiologists.
No one knows anything. In the 90s they said there would be too many anesthesiologists/CRNAs and look what happened. Could go either way so will make hay now as Blade suggests.
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The label on the syringe just says "ANESTHESIA".
D
deleted643396
Ok, I’ll bite the keep the discussion going for the new grads on here. What does “make hay while the sun is shining” mean in the current market? Locums? PP (if a good/safe one still exists)? Hospital employment?
From what I can tell, full time employment jobs out there are ok, but not great. It’s certainly better than 2014-2017. However, everyone I know has a friend or acquaintance who is crushing it in the locums game. Is that really the answer if you want to “make hay?”
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I’m in this boat. Thought I wanted to do private practice but just initial talks show how much they take advantage until you make partner. Hospital w2 offering 600 with 12 weeks vacay and 40 hours a week. Private practice at 500 with 45-50 hours and 6 weeks off. When you make partner vacay up to 12 weeks. Haven’t been told the partner salary but can’t imagine it’s more than 650. The w2 hospital job seems like a no brainer.
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Where is this hospital w2 job? Gotta be in bfe.
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deleted1130227
I wouldn’t call it a no brainer. But it does seem the safe play. When the market turns, I promise you the hospital will be trying real hard to ratchet down salaries. You live contract to contract. Not to mention a simple non-renewal with a noncompete likely to be in force if you make the wrong enemy.
IF the private practice group stays in existence for a long time AND it is a true equal partnership, it is likely to be the better call long term. Roll the dice.
Note the capitalizations above.
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Alright there Liam Neeson. I'll give you a call if my daughter gets.......taken.
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My youngest sibling graduates June 2024 and has no business sense. I have to keep an eye out for them. They saw a w2 in the metro area here in midwest for 390k w2 and were like wow that's great. Then i looked and found just by driving 45-60 min and you are hitting 500's.
In midwest I would think in this market no one should be a w2 40 hrs for less than 450's? less desirable 500-550 and locums I am hearing in low to mid 300's/hr. Is this somewhat accurate?
If it were me in this field I would be locums milking the gravy train but we are not all wired the same.
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I don't see this job market easing up much over the next 4 years. In that time frame, you can make a lot of money, enjoy a nice lifestyle and/or complete a partnership track. I do think partnership needs to show value over locums or W-2 employment. That means income on the higher end of the spectrum. For many of you the "higher end" is quite clear but for the newbies higher end isn't mid-six figures any longer as that is the norm/median for 40-45 hours per week.
If you aren't making that median income for 40-45 hours then your job is subpar. That could be due to geographic locations, e.g., NYC, or academia but the fact remains that even a locums working 40 hours per week for 45 weeks makes a higher income. And when you consider the cost of that locums is an additional 30% to the hospital, the W-2 anesthesiologist should easily be able to negotiate a fair salary for a fair work schedule.
The days of being exploited are over. AMCs can only exploit you because you allow it. The cause of your high workload for low/median pay is because you aren't willing to look elsewhere. 2023 is the year many of you finally wake up from the nightmare. Do you need to take the red pill?
IMHO, the only anesthesiologists who should be earning 25th percentile MGMA income should be in academics; the rest should say "no mas" and find another gig.
en.wikipedia.org
If you aren't making that median income for 40-45 hours then your job is subpar. That could be due to geographic locations, e.g., NYC, or academia but the fact remains that even a locums working 40 hours per week for 45 weeks makes a higher income. And when you consider the cost of that locums is an additional 30% to the hospital, the W-2 anesthesiologist should easily be able to negotiate a fair salary for a fair work schedule.
The days of being exploited are over. AMCs can only exploit you because you allow it. The cause of your high workload for low/median pay is because you aren't willing to look elsewhere. 2023 is the year many of you finally wake up from the nightmare. Do you need to take the red pill?
IMHO, the only anesthesiologists who should be earning 25th percentile MGMA income should be in academics; the rest should say "no mas" and find another gig.
Red pill and blue pill - Wikipedia
D
deleted545787
Even in academia, some make mid 6 fig. So I would really know your worth. May the shortage never end, bahaha
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Hahah in the Carolinas. It’s actually a really nice city. Not a bad place to live at all. But yeah it’s not a Chicago, Houston, Miami.
The private practice group is a small one but they have existed for like 30 years. I just hate the idea of the guy working down the hall from me making money off my back. Especially when I’m cardiac trained and are adding something to the group that they are looking for and need. Maybe it’s highly negotiable though. They have been looking for 4 months or so now. If on Nov/Dec they haven’t found someone bet it gets even better.
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Yes, the job is negotiable. Have you vetted the practice entirely? That means not just the pay but the entire practice. This is a new paradigm and "exsting for 30 years" means very little if the group needs a new stipend or larger stipend to make payroll in this environment. Reimbursements under the no surprise act are under pressure and salaries for CRNAs are at the highest level ever. New Anesthesiologists expect to start with an income well in excess of $350k with shorter partnership tracks.
Is the group prepared for the new paradigm? Is the administration willing to provide the subsidy required for the group to thrive once you make partner?
Is partnership income expected to remain stable once your buy-in is complete? How many years as a partner until your total salary package exceeds a W-2 employment position? For example, 2 years to partner plus 3 years as partner works out to an average income of "X." If you took another W-2 position elsewhere what would your income be over those same 5 years, income"Y"? When does X exceed Y?
Again, don't get hung up on the longevity of the group, but rather their odds for survival in this new paradigm over the next 5 years.
As an example, CRNA salaries have increased $40,000 per CRNA over the past 3 years. Is this group able to survive and thrive such increases?
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Pain in the anes you inspire me to pull the trigger and leave my full time job for full time locum. Just too scared to pull the trigger
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Even in LA my partner who is a fresh anesthesia grad has plenty of offers starting her at 400-450k with great benefits. So yeah I’d say you’re correct.
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Carolinas as in Charlotte, Raleigh, the research triangle or Greenville, Wilmington, high point?
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deleted1130227
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Now and the last few years have been a wonderful time to renegotiate and switch positions to vastly improve one's financial position and/or lifestyle. The issue still remains that anesthesiologists work hard for their keep with declining reimbursement to the point that it is the norm for groups to need subsidies to survive. This financial crunch means less than desirable working conditions such as limited supplies (i.e. my hospital got rid of the "expensive" difficult airway cart and replaced it with GlideScope fiber-optic and decided we can't use alfentanil, sufentanil, or desflurane) and limited support staff (i.e. number of anesthesia techs, anesthesiologists, and CRNAs has steadily decreased with limited plans to replace -- just "readjusted" the adequate number much like solving poverty by lowering the income threshold). Maybe I'm jaded by my own institution. AMCs appear to be struggling with the increased cost of doing business as well (good thing IMO). But the No Surprises Act ensures a race to the bottom for anesthesia reimbursement. The future appears to eventually be direct hospital employment.
Some have pointed out that the demand for anesthesiologists and CRNAs has taken reimbursement for services by insurance companies out of the equation. I believe that to be true in the current climate. The goal of the hospital is to keep those facility fees rolling in from the OR and anesthesia is just an expense that will potentially not pay for itself. However, eventually, the paradigm will shift and I believe that the corporate overlords will realize that they can control the practice environment of anesthesiologists with a hospital employed model and manipulate it to cut expenses as much as possible.
Some things that could happen under a job market where there are mostly hospital employed anesthesiologist positions:
Some have pointed out that the demand for anesthesiologists and CRNAs has taken reimbursement for services by insurance companies out of the equation. I believe that to be true in the current climate. The goal of the hospital is to keep those facility fees rolling in from the OR and anesthesia is just an expense that will potentially not pay for itself. However, eventually, the paradigm will shift and I believe that the corporate overlords will realize that they can control the practice environment of anesthesiologists with a hospital employed model and manipulate it to cut expenses as much as possible.
Some things that could happen under a job market where there are mostly hospital employed anesthesiologist positions:
- Make 4:1 ACT model the standard. I've heard of multiple groups here in the NE utilizing this for even complex cases like hearts.
- Utilize QZ billing. Need to subsidize the anesthesia groups anyway, may give up entirely on attempting to recoup cost of anesthesia or having a safe anesthetic for patients. Had a graduate of our program accept a position in FL like this (supervise 4 rooms and 2 QZ rooms routinely).
- CMS could change their mind about appropriate ratios. Lobbyists may be able to convince unsuspecting lawmakers that a high ratio like 6:1 is safe.
- With contract negotiations, corporate could point out to physicians that they don't make any money for the hospital to justify salary/bonus decreases.
- Place unreasonable demands on physicians trying to stretch their dollar further. For example, I can see hospitals accepting that an anesthesiologist needs to supervise multiple rooms in the OR but routinely play Russian Roulette with NORA cases through QZ billing in an effort to get as many procedures done as possible. I foresee more NORA in the future.
- Possibility of technology justifying less anesthesiologists to make up for the lack of supply. At our facility, there is no in house ICU attendings just TeleICU with a camera on patients and an attending who knows where that can answer questions for mid-levels and residents. This can potentially translate into our field with TeleAnesthesia - an environment much like an air traffic controller where an anesthesiologist sits in a room near the OR with a bunch of anesthesia records open on computer monitors to "supervise" multiple rooms at one time. This would also open up the possibility of "safely" doing QZ billing for all the rooms - one anesthesiologist for some insane number of rooms (i.e. ten). Maybe legislation will change that this will meet CMS criteria for supervision so you could do supervision for 4 rooms like this?
- And the issue that has been discussed ad-nauseam about letting CRNAs do their own thing without any physician on the premise. If corporate medicine is in charge, they can just decide to do this as opposed to a physician led group in charge which would object to this. Need I say more?
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What are your thoughts on the increasing prevalence of the employment model?
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Everything sounds great on an Internet forum, locums can be great or terrible just like any job. I did it for a couple years and much prefer being in PP. I make less now and it’s still a much better job. Grass is not always greener
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Greenville South Carolina lol.
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Don’t sweat the small stuff. IMHO, every job is an employment model going forward. All that matters are the terms of That employment. No group is secure long term any longer based solely on insurance reimbursement. Groups need hospital support in one form or the other to stay competitive. So, does the administration recognize the need and value for that support? Will your job be solo MD or supervising crnas? What will the ratio of that coverage be? I highly recommend you avoid 1:4 coverage if at all possible unless The pay reflects that level of work.
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Locums helps all of us get better jobs with better pay and working conditions. The cost of a locums anesthesiologist to the hospital can exceed
one million dollars per physician. This makes the administrators take note of your value and should improve working conditions. If on the other hand the administrators want to abuse you,my advice is to go elsewhere and make them pay that $1 million plus cost to replace you. I’m not a big fan of doing locums either but unfortunately, the locums market has forced many hospital administrators to finally pay you a fair wage; this is a good thing for all of us.
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Agreed. Locums almost always means travel. Planes, trains, automobiles, hotels. New facilities, new faces, new anesthesia cart where ______ isn't in the spot it was in at the last locums gig.
There's a lot to be said for sleeping in your own bed and working at the same hospital all the time.
I make less per hour now than I did at my moonlighting gigs when I was in the Navy a couple years ago. I'd like to earn more but being a partner in a private group 14 minutes from my super awesome house is worth something to me.
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Also a lot of ASC gigs that are 7-3 no call no weekends tend to fall in that bottom quartile salary range. Some people are willing to take a sizeable pay cut for routine and predictability.
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The world has changed a lot. You can now get jobs at hospitals with less work than some ASCs for the same pay. The provider shortage is real and many can now make a deal that wasn't possible 2 years ago. I am not saying all ASC jobs are bad but many work you much harder than a hospital position with very limited call.
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You are spot on. Know your worth. Too many of you are being exploited because of the job market 3-4 years ago. This isn't 2018-19 any longer. Wake Up.
These days $350K buys you a day doc working 32-35 hours per week with a full benefit package (a real nice one at that). Typically, its $350 for 4 days and $400K for 5 days per week (0700-1500) plus full benefits. If your pay isn't significantly higher than that amount you are being exploited by your group, hospital and/or administrators. So, when you factor in call pay, night work and weekend work the salaries are much higher as those hours carry a premium.
Imagine how much the plumber will charge you on Saturday night at 0300 to unclog your toilet? Know your worth.
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This is for sure true. I know of an ASC with frequent 0545-0600 start times. Late rooms often past 1800 with recovery times stretching until 2100 or later. Weekend cases. And medically complex patients (that really shouldn’t be at an ASC). Might as well be a hospital.
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The real problem i see from administration view on anesthesiology is they have no control of staffing anymore. Zero control but they also want to expand the case load. It’s simply doesn’t work. Thus the subsidy which they are loath to increase.
When companies like Usap (one of the original 3), not the later ones) are barely turning a profit even with 50% plus commercial payor mix it’s a huge problem with no subsidy. They are still making money but it’s severely deceased.
Couple of I see is with the act model
1. The act models of the old days are gone. Crna’s simply do not want to work 5 days a week. So it’s hard to fill the 7-3 slots consistently especially Monday’s and Fridays with crna’s. Many just want to work 2 or 3 days a week.
2. Weekend coverage with crna’s is a pain.
As for the MD only model. Just too many sites to cover and not enough docs. To many long rooms. Docs in rooms consistently 8 hours. And those docs are Two MD only true private models I’ve know in the past 2 years (partners make 600-800k generally) have abandoned the hospitals. Kept their surgery centers. Told the hospital they weren’t gonna to renew it. Management companies tried to come in and low ball w2 docs at first 400k. Than 450k. Than had to up it to 500k plus calls just to entice docs to sign. Good for new grads. But the fact partnership model is a thing of the past.
So not sure how management companies are making money. Partnership track was 30%,20%, then 10% buy in. Hospital has agreed to subsidize locums cost for the first year. So no skin off the management companies backs.
25-30 years vets are probably the best anesthesiologists in my practice. The most rounded. I respect their advice.
When companies like Usap (one of the original 3), not the later ones) are barely turning a profit even with 50% plus commercial payor mix it’s a huge problem with no subsidy. They are still making money but it’s severely deceased.
Couple of I see is with the act model
1. The act models of the old days are gone. Crna’s simply do not want to work 5 days a week. So it’s hard to fill the 7-3 slots consistently especially Monday’s and Fridays with crna’s. Many just want to work 2 or 3 days a week.
2. Weekend coverage with crna’s is a pain.
As for the MD only model. Just too many sites to cover and not enough docs. To many long rooms. Docs in rooms consistently 8 hours. And those docs are Two MD only true private models I’ve know in the past 2 years (partners make 600-800k generally) have abandoned the hospitals. Kept their surgery centers. Told the hospital they weren’t gonna to renew it. Management companies tried to come in and low ball w2 docs at first 400k. Than 450k. Than had to up it to 500k plus calls just to entice docs to sign. Good for new grads. But the fact partnership model is a thing of the past.
So not sure how management companies are making money. Partnership track was 30%,20%, then 10% buy in. Hospital has agreed to subsidize locums cost for the first year. So no skin off the management companies backs.
20 year veteran is between ages 49-51 in my practice. They are in the prime of their careers. The fastest and most efficient anesthesiologists who rarely cancel cases.
25-30 years vets are probably the best anesthesiologists in my practice. The most rounded. I respect their advice.
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ASC work also tends to be ACT work, often 4:1.
Some of the worst days of my career have been banging out the paperwork for 30+ cataracts plus other high turnover rooms. Just talking to 40+ patients per day is exhausting. Attesting to my presence at the legally required times wasn't always easy.
Respect and sympathy to those who make a living doing that ... 7-3 no weekends no call sounds nice. But while the hours are good, the actual minutes are soul sucking.
I'd much much rather have 45-50 pleasant-ish hours, mostly solo, with a modest call burden, than some meat-movin' surgicenter preop-pacu-chart-monkey job.
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How non-compete clauses cost Americans $300 billion a year
The Federal Trade Commission estimates a ban on non-competes would expand opportunities for 30 million Americans and raise wages by nearly $300 billion a year.
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Where is this hospital job? I haven’t seen packages like this out there
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The worst ASC are the one that really need an extra CRNA. I’ve been at asc with 2 gi (45 preop) rooms plus a peds ent room. (8-10 preops)
Or one gi room (20 preops) . One peds ent room (8-10 preops). and one cataract room (30 preops)
Probably the worst job (I was 1099). But it ran from 630am-6pm consistently. Bad job. Even at than roughly 380-400k 1099 a year based on 7 weeks off (in 2016 that was decent pay). And I was working just 4 days a week. Couldn’t handle all 5 days a week.
You really needed an extra body to start a peds case or gi room. No one got breaks especially with peds running. Peds plus gi going same time is a recipe for disaster. Anything can happen quickly. Even with experienced crna’s.
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Wow 400k 1099? Someone was making a million off your work.
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That was 2016. Market not great 2012-2018 in many places. Atlanta northern suburbs mednax trying to offer in the high 200s for Friday Saturday Sunday weekend coverage as well. So was Orlando Sheridan Division.
That’s why u gotta be careful of ASCs. 4 days a week with no calls and no weekends doesn’t sound bad on paper. Workload is what matters. Hospital work with built in inefficiencies is better.
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Seen many of these jobs advertised.. most are straight up lies to get some dope on a rope. Please direct me to the surgery center that abruptly closes their doors at 3 or the anesthesia group that sends relief promptly at 3. ASC work means you stay as late as they need you to.. some days that’s 1pm others it means pack dinner and call the kids to say goodnight. If you want shift work go to AA school.
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I'd rather die than work 545-1800 + weekends
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I did a per diem shift today at an ASC.
I got paid $220/hr which is obviously under market.
But….
I did four MAC cases (lipomas - all could have been done in the office), by the end of the case, I had given 2 mg midazolam and 100 mcg fentanyl to each one.
Turn overs were long so I was never rushed.
Not a bad day.
I got paid $220/hr which is obviously under market.
But….
I did four MAC cases (lipomas - all could have been done in the office), by the end of the case, I had given 2 mg midazolam and 100 mcg fentanyl to each one.
Turn overs were long so I was never rushed.
Not a bad day.
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But a sad day. A very sad day.
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deleted87051
Almost as sad as the existential angst of the eye room.
“How did I end up here? What am I doing here? Why is the surgeon berating this deaf non-English speaking patient in English?”
“Do you see the light?! Look at the light!!”
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I worked at two places where the optho surgeons would request/demand GA for what would otherwise be MAC cases “because the patient can’t speak English”. At one of those places an added justification was “because it’s a resisent case and it will take a long time”. This all made the optho room particularly detestable.
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Outstanding!
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No weekends at ASC. The lure is no calls and no weekends.
The variable question is what is the workload. That matters more. That’s the trade off for no calls and no weekends. And most Stand a lone asc still can pay 1099 which also appeal to people.
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Well the poster I replied to said that asc does weekends...
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I can confirm they definitely do at least a half day of cases 2x a month.
D
